Cecostomy is a useful surgical procedure - Study of 113 colonic obstructions caused by cancer

PURPOSE: There is a large choice of treatment for obstructing carcinoma of the left colon. We report our experience of tube cecostomy as the initial t reatment far obstructing colonic carcinoma followed by elective resection. METHODS: From 1975 to 1995, 113 patients presenting with colonic obstructio n caused by cancer were initially treated by tube cecostomy. RESULTS: The c ecostomy was per formed under local anesthesia in 26 cases (23 percent) and general anesthesia in 87 cases (77 percent). In the postoperative period 1 5 patients died (13 percent) and 26 (23 percent) had wound infection in the area around the cecostomy. A second operation performed on the 98 survivin g patients comprised 74 left colonic resections with anastomosis, 9 without anastomosis (Hartmann's operation), 1 right colectomy, 3 total colectomies eliminating the cecostomy, 3 internal bypasses, and 8 proximal lateral col ostomies. Surgical closure of the cecostomy was performed during six of the second operations. No deaths occurred from any of the second operations. T he cecostomy closed spontaneously in 78 patients (89 percent). In ten cases (11.4 percent) a third operation was performed to close the cecostomy, wit hout mortality. CONCLUSIONS: Comparison our cecostomy results with publishe d studies of proximal diverting loop colostomies for the same indications s howed comparable mortality after the first operation. Cecostomy decrease mo rtality of the second operation. This retrospective study suggests that cec ostomy is a useful and less invasive surgical procedure for patients presen ting with colonic obstruction caused by cancer.